Psychiatrists have called on the Irish Government to lift the embargo on public service recruitment, claming unless it is lifted a radical plan to change how people with mental health problems are treated will never be implemented.

It is estimated that one-in-four of the population is affected by mental health problems at some stage in their lives. This estimate is soundly based upon ‘collated’ national and international research data.

Launched in January 2006, and endorsed by the government, amid great fanfare ‘the plan’ A Vision For Change, recommended closing mental hospitals across the state and using the ‘ quite considerable funds generated’ to improve mental health services within the broad community. It was to move health-care to a community-based setting – where multidisciplinary teams would look after people. It recommended recruiting an additional 1,800 staff for mental health services and was to be implemented over the next 10 years.

Mental Health Ireland, which represents 96 local mental health associations throughout the state, said the HSE (Health Service Executive), had failed to appoint a ‘National Mental Health Services Directorate’ which was a key recommendation of ‘A Vision for Change’ policy. It believes that many of the report’s recommendations will not be implemented until this is done. Accusing the HSE of “lacking in the urgency” which the plan requires. It called on the Government to “fast-track” the plan.

Psychiatrist and spokeswoman for the Irish Psychiatrists Association, Dr Siobhan Barry, which represents more than 60 psychiatrists, said that if the (plans) were to have any credibility – then some kind of derogation was needed on the public service recruitment embargo.

“The embargo has contributed considerably to the delay in getting things moving”, said Dr Barry. “The delivery of the plan {A Vision for Change} is extremely disappointing”.

Dr Barry also criticised the level of funding for new services in mental health. She said the figure in this category had been reduced by €1million to €25 million in the last Budget, compared with the 2006 budget, she said the 2007 Budget figures included some costs for implementing aspects of the Mental Health Act and the Criminal Law Insanity Act, introduced last year, rather than spending purely on services.

Dr Barry said the recommendations in the plan were supposed to be delivered over seven to 10 years. “We need to focus better on it, to deliver it,” she said.

The IPA publishing a (yearly) progress report on the implementation of the plan – to ensure that the policy was put into practice said that its members were “dismayed” that almost no progress had been made yet in delivering key recommendations in the plan.

Dr Barry, consultant psychiatrist and co-author of the IPA report, said the health service was “littered” with reports that were never implemented and the IPA was determined it would not happen in this case.

“No capital programme crucial to replace the crumbling and shoddy parts of the service has yet been put in place,” she said. “This, in a situation when we are currently enjoying a property bonanza. Seems quite crazy.”

Dr Eamonn Moloney, consultant psychiatrist and co-author of the progress report, said almost one-third of community mental health teams had less than half the staff they needed. He said 24 posts would be provided nationally this year, but 660 staff was required. “At the same rate of development, it will be 25 years before A Vision for Change will be implemented,” he said. He also highlighted a lack of services and dedicated beds for older people with mental health problems, particularly for older people with dementia.

“If mental health doesn’t get it in the good times, then God knows what’s going to happen in the leaner times,” he said.

A statement from the HSE said “a great deal of progress” had been made and “sustained roll-out will continue during 2007 with a further €25 million being allocated to achieve the report’s proposals”.

Martin Rogan, HSE assistant national director for mental health, said the sale of mental health facilities would continue this year, with the proceeds reinvested in mental health facilities. Four child and adolescent in-patient facilities would be constructed and eight more child and adolescent multi-disciplinary teams would be rolled out, he said, and the ‘National Service Users’ Executive would be launched on January 31 st 2007.

Mental Health A Right:

“Mental-Health is no less a human right, than physical health and reasonable social comfort and security.” …

“Experience in some countries have demonstrated that blocking the access of people with mental illness to treatment, can result in more deplorable conditions for the mentally ill person and for his/her family and community than if he/ she were confined in a mental health facility”. …

“As a result of the major progress in the treatment of mentally disordered and mentally retarded persons which has occurred during the past three decades, it is possible for many individuals with mental illness to be treated while living in the community, and/or be transferred from institutional care, to the open life of the community.

If they are refused their right to work because of mental illness, their re-socialization is slow and their human rights are infringed. In general it is now possible to envisage the necessary after-care as one of the functions of the basic health services”. … The foregoing quotes are ‘extracts’ from the memorandum of the World Health Organisation (WHO) that it presented to the 1970 session of the General Assembly of The United Nations.

‘The state shall recognise the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. … [And] shall strive to ensure that no child is deprived of his or her right of access to such health care services’.

The World Health Organization (2003), in Caring for Children and Adolescents with Mental Disorders: Setting WHO Direction, states that:

“The lack of attention to the mental health of children and adolescents may lead to mental disorders with lifelong consequences, undermines compliance with health regimes, and reduces the capacity of societies to be safe and productive”.

Background History:

During the 1980s in Ireland, The Irish Government followed the steps of the then British Prime-minister and conservative party leader Margaret Thatcher by following what became known as ’The Community Care Initiative’. By emptying old style mental hospitals, such as ‘Grangegorman’ in Dublin.

However, ‘community care’ turned out to be a cynical-penny-pinching exercise, which in fact meant, saving money on staff and overheads, the reality for most of the hospitals patients who ended up in this new

‘Community care’ was a dingy bed-sit, which they were not equipped to look after and bitter, cruel, exploitation by ‘niggard’ and greedy landlords.

*Over decades of institutional-care, the state deprived these people of their independence and their ability to look after themselves and made them totally-reliant on full-time carers for every need that they had. Then having deprived these people of their natural ability to look after themselves and live within a community, the state tipped them straight back into it.

(* Authors note: see Rehabilitation Mental Health Services).

What thereafter, was to happen to these unfortunate people?, in a country that professed to the world that they were good, holy, Christian, and an absolute pillar if virtue, especially in the area of human-rights, a subject dear to the heart of the Irish nation, and evidenced by the endless lectures Ireland has delivered to the errant outside world, expressing the wish that such nations who were tending to disregard the ’human rights’ and therefore the ’natural human dignity’ of their citizens, should amend their ways and follow the example that Ireland had set for its-self and wished that the rest of the world should follow its example. But things were not quite as they seemed to be. The delivery of health care is not like providing an electricity or telephone service, where the only difference between households in the service they receive is the amount of electricity that they use or the number of lines connected. Sister Stanislaus Kennedy, had this to say about ’community care’; “the phrase ’community care’ began to be used sometime in the early 1950s in Britain, precisely when, we do not know. Precisely is meant by the phrase, is not clear either. I have tried and failed to discover in any precise form the social origins of the term ’community care’. Political opinion and public may be misled or confused, if English social history is any guide, confusion has been the mother of complacency. What some hope will one day exist, is suddenly thought by many to exist already. About 1960, in Britain, a term appeared in the vocabulary of the Social Services, it was ’community care’. Somehow it sounded right and was quickly taken up; it still lacks a single precise definition. Many maintain that Enoch Powell. M.P. coined the phrase, as it was associated with his name, because of ’The Blue Book’. ’Health and Welfare: The Development of Community Care, which was published in 1963, when he was UK Minister for Health.

Schizophrenia:

Schizophrenia is a mental illness, characterized by disordered-thinking, delusions, hallucinations, emotional disturbance and withdrawl from reality.

Schizophrenia, is commonly thought to disproportionately affect people in the lowest socio-economic groups, although, some people claim that socially-disadvantaged persons with schizophrenia are only more visible than their more privileged counterparts not more numerous. Many people still see mental illness as a stigma whatever the cause. About one in every hundred Americans-including as many as one-third of homeless adults suffers from schizophrenia. Advancing knowledge about the role of the brains physical structures in mental illness should change our perceptions about such diseases, including depression and manic-depression. Mental illness afflicts more than 20% of all Americans, and about 40% per-cents of Americans with severe mental illness receive no treatment.

In the USA, schizophrenics occupy more hospital beds than do patients suffering from cancer, heart disease, or diabetes. At any given time, they account for up to half the beds in long-term care facilities and 40% of treatment days. With the aid of antipsychotic medication, to control delusions and hallucinations, about 70% of schizophrenics are able to function in society.

While the exact cause of schizophrenia is not known, it is belived to be caused by a combination of physiological and environmental factors. Studies have shown that there is clearly a hereditary component to the disorder. Family members of schizophrenics are ten times more prone to the disease than the general population, and identical-twins of schizophrenics have a 46% chance of having the illness themselves. Relatives of schizophrenics, also tend to have milder psychological disorders with some of the same symptoms as schizophrenia, such as, suspicion, communication problems, and eccentric behaviour. The initial symptoms of schizophrenia usually occur between the ages of 16 and 20 years, with some variations depending on type.Disorganised schizophrenia tends to begin early, usually in adolescence or young adulthood, while paranoid schizophrenia tends to start later, usually after the age of 25 or 30. In rare cases, schizophrenia may have its onset during childhood, and has been known to appear as early as five-years-of-age, occurring primarily in males, it is characterised by the same symptoms as adult schizophrenia. Diagnosis of schizophrenia in children can be difficult because delusions and hallucinations may be mistaken for childhood fantasies. It is important for the condition to be diagnosed as early as possible, the longer the symptoms last, the less well they respond to treatment.Even when treated, schizophrenia interferes with normal development in children and adolescents and makes new-learning difficult.

Researchers have found correlations between childhood behaviour and the onset of schizophrenia in adulthood. A 30 year longitudinal research project studied over 4,000 children born within a single week in 1946 in order to document any unusual developmental patterns observed in those children who later became schizophrenic. It was found, that a disproportionate number of them learned to sit, stand and walk late. They were also twice as likely as their peers to have speech-disorders-at the age of six and have played alone when they were young. One study, found that the routine physical movements of these children, tended to be slightly abnormal, in ways that most parents wouldn’t suspect were associated with a major mental illness, and that the children also tended to show fear and anger to an unusual degree.

It is estimated that 15 to 20% of schizophrenics commit suicide out of despair over their condition or because the ‘voices’ they hear tell them to do so, and up to 35% attempt to take their own lives or seriously consider doing so. Between 25 and 50% of people with schizophrenia abuse drugs or alcohol. The vast majority of both suicide attempters and completers have evidence of at least one major psychiatric disorder. These disorders are most often, affective disorders, causing changes in moods or emotions. Major depressive disorder is the single biggest factor for attempted and completed suicide.

The tendency of schizophrenics to discontinue medication is very harmful.

Each time a schizophrenic goes-off medication, the symptoms of the disease return with even greater severity and the effectiveness of the drug is reduced.

The onset of schizophrenia may be acute, developing over a few weeks or even days, or insidious. ICD-10 recognises seven categories of the disease; paranoid, hebephrenic, catatonic, simple, undifferentiated, residual and post-schizophrenic depression. Life events have been implicated in the precipitating of the first episode of illness in about 60% of patients, however, life stresses are involved in precipitating all acute psychiatric disorders and are not specific to schizophrenia. It is well known, that use of cannabis can provoke relapse in patients with schizophrenia or manic-depressive illness.

The main impact of cannabis abuse on marriage is related to the relapse which it induces in some patients with major mental-illness and the effects of euphoria and secondary *apathy is associated with the heavy persistent use of the drug. (*Authors note: Apathy; = lack of emotion). Cocaine, amphetamines (speed), hallucinogens, and cannabis, are the most readily available drugs on the black market, and although not associated closely with physical dependence, they are widely abused, due to their mood-enhancing properties and are also associated with serious psychiatric disturbances in many abusers.

Schizophrenia is the disorder which is at the nub of psychiatry, and created the necessity to build mental hospitals to house such patients Moreover, it is the disease which has led to the stigmatisation of psychiatry and to the erroneous association between mental-illness and violence. Most patients with psychiatric disorders do not commit crime, and conversely most crime is not committed by those who are psychiatrically ill. In spite of these facts, there is a common perception amongst the public, that the two are inextricably linked, particularly in relation to violent offences.

Immigration has long been believed to be associated with an increased risk of developing schizophrenia, leading to speculation that the most unstable in a population migrate, this has not been verified by research, but data based on hospital-admission-data, as distinct from out-patient data, do confirm the dramatically higher admission rate for immigrants, a finding that has become politically sensitive in Britain.